HIV associated nephropathy natural history, complications and prognosis
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]Ali Poyan Mehr, M.D. [2];Associate Editor(s)-in-Chief: Krzysztof Wierzbicki M.D. [3]Shakiba Hassanzadeh, MD[4]
Overview
HIV-associated nephropathy (HIVAN) will progress to end-stage renal disease (ESRD) in a few weeks to months without treatment. However, early diagnosis and treatment has shown better outcome.
Natural History
- If left untreated, HIV-associated nephropathy (HIVAN) will progress to end-stage renal disease (ESRD) in a few weeks to months.[1]
- Treatment with cART has shown 60% reduction in the developement of HIVAN.[1]
- Treatment with cART has shown 38% slowing in the progression of HIVAN towards ESRD.[1]
- Early diagnosis and Immediate treatment has shown better outcome.[1]
Complications
Possible complications that are associated with HIV-associated nephropathy include:
- End-stage renal disease (ESRD)[1]
Prognosis
- Before the advent of cART therapy, the prognosis of HIV-associated nephropathy was fatal. The mortality rate during this time was 100% within 6 months.[1]
- Today, the prognosis of HIVAN with the availability of cART therapy still remains grim,[1] however, treatment with cART has increased renal survival rate.18190325
- Early diagnosis and Immediate treatment has shown better outcome.[1]
- Treatment with cART has shown 60% reduction in the developement of HIVAN.[1]
- Treatment with cART has shown 38% slowing in the progression of HIVAN towards ESRD.[1]
- The current first and second year survival rate of HIV-associated nephropathy is estimated to be around 63% and 43% respectively, with the use of HAART therapy.[2]
The following are favorable prognostic factors:
- Patients on HAART therapy
- Patients with low-grade proteinuria
- Patients who have a suppressed HIV-1 viral load
- Patients who express a normal renal echogenicity
- Patients with CD4 levels that between 200 and 500 cells/mm3
- Patients who have higher estimated glomerular filtration rates
The following are poor prognostics factors:
- Patients not receiving HAART therapy
- Patients with high-grade proteinuria
- Patients who have under suppressed HIV-1 viral load
- Patients who express a large renal echogenicity
- Patients who have CD4 levels that are below 200 cells/mm3
- Patients who have lower estimated glomerular filtration rates
References
- ↑ 1.00 1.01 1.02 1.03 1.04 1.05 1.06 1.07 1.08 1.09 Atta MG, Lucas GM, Fine DM (2008). "HIV-associated nephropathy: epidemiology, pathogenesis, diagnosis and management". Expert Rev Anti Infect Ther. 6 (3): 365–71. doi:10.1586/14787210.6.3.365. PMID 18588500.
- ↑ Atta MG, Choi MJ, Longenecker JC, Haymart M, Wu J, Nagajothi N; et al. (2005). "Nephrotic range proteinuria and CD4 count as noninvasive indicators of HIV-associated nephropathy". Am J Med. 118 (11): 1288. doi:10.1016/j.amjmed.2005.05.027. PMID 16271919.